Scientists call for a contact tracing app regulator

Rolling out contact-tracing apps for COVID-19 without considering their wide ethical and social implications can be “dangerous, costly and useless,” argue four digital-ethics experts in a Comment piece in Nature.

COVID-19 contact-tracing apps alert people who have come into contact with someone carrying the virus SARS-CoV-2 and advise them how to respond. They are already in use, for example, in Australia and Singapore, and are being developed by France, Germany, Italy, the United Kingdom, the United States and others. However, Jessica Morley, Josh Cowls, Mariarosaria Taddeo and Luciano Floridi argue that collecting sensitive personal data potentially threatens privacy, equality and fairness.

The authors set out 16 questions that governments and app developers should answer to assess whether an app is ethically justifiable. Most attention so far has focused on data privacy, but the authors outline other concerns. For instance, if not everyone can access the app—such as people who do not have a smartphone—then take-up might be too low to slow the pandemic’s spread, and would amplify inequalities in society. If the app fails, it becomes unnecessary and thus unethical. An independent body needs to be in place to oversee its development and use. Different countries have various levels of digital literacy, and therefore have different impacts to weigh.

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Cancer drugs cause large cells that resist treatment; scientist aims to stop it

A cancer therapy may shrink the tumor of a patient, and the patient may feel better. But unseen on a CT scan or MR image, some of the cells are undergoing ominous changes. Fueled by new genetic changes due to cancer therapy itself, these rogue cells are becoming very large with twice or quadruple the number of chromosomes found in healthy cells. Some of the cells may grow to eight, 16 or even 32 times the correct number. Quickly, they will become aggressive and resistant to treatment. They will eventually cause cancer recurrence.

Daruka Mahadevan, MD, Ph.D., professor and chief of the Division of Hematology-Oncology in the Long School of Medicine at UT Health San Antonio, has studied this progression for 20 years. In a paper published in April 2020 in the journal Trends in Cancer, he and co-author Gregory C. Rogers, Ph.D., explain a rationale for stopping it.

“When you give therapy, some cells don’t die,” explained Dr. Mahadevan, leader of hematology and medical oncology care at the Mays Cancer Center, home to UT Health San Antonio MD Anderson. “These cells don’t die because they’ve acquired a double complement of the normal chromosomes plus other genetic changes. Many types of chemotherapy actually promote this.”

Dr. Mahadevan found that two cancer-causing genes, called c-Myc and BCL2, are operative in “double-hit” high-grade lymphomas, which are incurable. “These genes are part of the problem, because when they are present, they help the lymphoma cells to live longer and prime them to become large cells with treatment,” he said.

Although the drugs seem to be working, once therapy is stopped, the large rogue cells (called tetraploid cells) start to divide again and become smaller but faster-growing cells, driven by c-Myc and BCL2.

“It’s a double hit, a double whammy,” Dr. Mahadevan said.

To counter this, Dr. Mahadevan seeks to find drugs that prevent or treat the rogue cells’ acquisition of multiple chromosomes. He has identified a small-molecule inhibitor that shows promise in cell experiments in the laboratory. “We have data to show that it works,” he said.

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Researchers identify mechanisms that make skin a protective barrier

A Mount Sinai research team has identified one of the mechanisms that establish the skin as a protective barrier, a breakthrough that is critical to understanding and treating common skin conditions including eczema and psoriasis, according to a study published Thursday, May 28, in the scientific journal Genes & Development.

One of the most important roles of the skin is to act as a barrier that prevents water loss and protects the skin from pathogens. Failure of this protective function contributes to dermatological diseases. The research team led by Sarah E. Millar, Ph.D., Director of the Black Family Stem Cell Institute at the Icahn School of Medicine at Mount Sinai, found that the scaffolding protein, histone deacetylase 3 (HDAC3), is essential for proper skin development and barrier formation.

The group found that mice lacking HDAC3 specifically in the epidermis—the outermost layer of the skin—fail to develop a functional skin barrier and die shortly after birth due to dehydration. The team’s extensive research describes a complex process in which HDAC3 regulates expression of its target genes in the epidermis by interacting with multiple DNA-binding proteins.

“HDAC3 is particularly interesting to us, as it associates with different proteins in different tissue types to regulate its target genes,” says Katherine Szigety, an MD/Ph.D. student in the Millar Lab and first author of the study. “While HDAC3 has been studied in diverse contexts, its role and transcriptional partners in the developing epidermis had not been identified until now.”

HDAC3 is a member of a family of epigenetic regulators, known as histone deacetylases (HDACs), which control gene expression by changing the structure of genetic material. Understanding the biology of epigenetic regulation is an area of active scientific investigation, as many new therapeutics are designed to modify this process. With a focus on skin biology, Dr. Millar’s lab is studying HDACs because a group of drugs called HDAC inhibitors are used to treat cutaneous T-cell lymphoma, a rare cancer that affects the skin.

The lab’s research on HDAC3 builds on their previous studies of the related proteins HDAC1 and HDAC2 in skin development. The team discovered that the mechanisms by which HDAC3 regulates target gene expression are distinctly different from those involving HDAC1 and HDAC2.

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Preliminary results to nationwide SARS-CoV-2 molecular testing survey

The Association for Molecular Pathology (AMP), the premier global, molecular diagnostic professional society, today released the preliminary results of its April 2020 SARS-CoV-2 Testing Survey for clinical laboratories. The anonymous survey was created and administered to document clinical laboratory efforts and experiences. The results will be used to help inform future advocacy and clinical practice programs related to pandemic responses.

AMP’s 67-question survey assessed many important aspects of SARS-CoV-2 molecular diagnostic testing, including methodology, performance, capacity, supply chain, regulatory, and reporting requirements. The preliminary results today included feedback from 118 representatives from US-based academic medical centers, commercial reference laboratories and community hospitals. 85% of these respondents are currently offering SARS-CoV-2 testing to patients, while another 10% are currently in the test validation phase. 90% of the laboratories recognize the need to increase diagnostic testing capacity further, and they are working hard to make this happen in the next few months. However, more than 70% of these laboratories have experienced supply chain interruptions that have resulted in significant delays, in many cases forcing them to validate at least three different diagnostic testing methods at the same time just in case the supply of reagents or materials runs out. These supply shortages have included everything from the RNA extraction kits, primers, probes, and enzymes to the physical sample collection materials, such as the swabs and containers for storage and transportation.

“Clinical laboratories across the country are working hard and being extremely resourceful in order to provide diagnostic SARS-CoV-2 testing to Americans, with the majority running at full staffing/testing capacity seven days a week,” said Karen E. Weck, MD, AMP President and Professor of Pathology and Laboratory Medicine, Professor of Genetics and Director of Molecular Genetics and Pharmacogenomics at University of North Carolina Chapel Hill. “However, AMP members know more testing is needed as the country begins to reopen. We are continuing to deploy multiple testing methodologies to overcome supply shortages, increase capacity and improve turnaround times.”

Based on the common themes found in the survey results, AMP is recommending that federal, state and local governments:

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Parents struggling to provide for families during pandemic

The COVID-19 pandemic poses risks to children’s health, well-being, and development as parents struggle to provide for their families, according to a survey released by the Urban Institute.

The Urban Institute’s Health Reform Monitoring Survey was conducted between March 25 and April 10, 2020. The analysis included responses from 9,032 adults (aged 18 to 64 years).

The researchers found that more than four in 10 (43.3 percent) parents living with children younger than 19 years reported that they or a family member lost a job, work hours, and/or work-related income because of the COVID-19 outbreak. Rates were higher among Hispanic (62.2 percent) and black parents (49.7 percent) versus non-Hispanic white parents (36.5 percent). Due to the outbreak, one-third of families reported the need for someone in the family to stay home from work to care for children, and 16.5 percent reported difficulty arranging child care. Lower-income parents and Hispanic parents reported being less likely to work from home versus higher-income parents and non-Hispanic white parents. Due to the pandemic, nearly one-third (31 percent) of parents reported their family had cut back spending on food, and three in 10 reported that their family had reduced savings or increased credit card debt. One-third of parents (33.8 percent) reported food insecurity and/or problems paying for housing, utilities, or medical costs in the previous month, but this was higher among lower-income parents (52.5 percent), Hispanic parents (51.7 percent), and non-Hispanic black parents (48.2 percent).

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Plasma from recovered coronavirus patients DOES help those suffering

Coronavirus patients treated with plasma from people who recovered from the infection are nearly TWICE as likely to survive than those who didn’t get the experimental treatment, study finds

  • Convalescent plasma therapy is when the liquid portion of blood is taken from a recovered coronavirus patient
  • It is transferred into a sick patient in hopes they will develop the antibodies needed to fight off the infection 
  • Researchers compared 39 coronavirus patients who received plasma infusions compared to 156 who didn’t 
  • About 18% of the plasma patients’ conditions worsened compared to 24% of the control group
  • Nearly 13% of plasma patients died and 72% were discharged in comparison  with 24% of control patients who died and 67% who were discharged
  • Here’s how to help people impacted by Covid-19

Convalescent plasma infusions help improve the conditions of patients hospitalized with the novel coronavirus, a new study suggests.

Researchers found the disease worsened in less than one-fifth of people who received blood plasma from a recovered coronavirus patient.

Comparatively, nearly one-quarter of patients who didn’t receive plasma saw their health rapidly decline.

The team, from Mount Sinai Hospital in New York City, found that patients who received plasma needed less oxygen support, were less likely die and more likely to be discharged from the hospital.

Health experts say plasma is a potentially game-changing treatment but, with few donations, doctors have to decide which patients receive it and which do not.   

Plasma therapy is when the liquid portion of blood is taken from a recovered coronavirus patient and transferred into a sick patient in hopes they will develop the antibodies needed to fight off the infection. Pictured: Melissa Cruz donates COVID-19 convalescent plasma at Bloodworks Northwest in Seattle, Washington, April 17

In a new study, about 18% of 39 coronavirus patients who received plasma infusions saw their conditions worsen (left) compared to 24% of the group who didn’t receive plasma (right)

Convalescent plasma therapy is an experimental treatment in which plasma from a recovered coronavirus patient is used on an infected patient in critical condition.

The hope is that the antibodies and immunity in the blood of a healthy person will be transferred to a sick person.

From this, the infected person will then develop the antibodies needed to fight off the coronavirus.

The treatment was first used during the Spanish Flu pandemic of 1918, a situation not far removed from the coronavirus pandemic.

For the study, published on the pre-peer-reviewed server medRxiv.org, the team compared 39 coronavirus patients who received plasma transfusions to 156 patients who did not.  

All of the patients had severe to life-threatening cases of COVID-19, the disease caused by the virus, and were hospitalized between March 24 and April 8 of this year.

Results showed the conditions worsened among 18 percent of plasma patients compared to 24 percent of those who didn’t receive it. 

On days one and seven, the plasma group had fewer patients with worse ‘oxygenation status,’ but the control group didn’t have any statistical difference. 

After 16 days, only 13 percent of plasma patients died in comparison with 24 percent of the control group.

Additionally, about 72 percent of plasma recipients were discharged from the hospital compared to 67 percent of control patients.

Nearly 13% of plasma patients died and 72% were discharged compared to 24% of control patients who died and 67% who were discharged. Pictured: Medical workers walk outside a special coronavirus area at Maimonides Medical Center in Brooklyn, New York, May 26

‘Convalescent plasma transfusion is a potentially efficacious treatment option for patients hospitalized with COVID-19,’ the authors wrote. 

They note that a randomized, controlled trial is needed to back up the study’s findings. 

The US Food and Drug Administration (FDA) approved the use of convalescent plasma for treatment last month.

‘Prior experience with respiratory viruses and limited data that have emerged from China suggest that convalescent plasma has the potential to lessen the severity or shorten the length of illness caused by COVID-19,’ the agency said in a statement on April 16.

However, the FDA added it must be given on case-by-case basis, and patients who receive it must be experiencing conditions such as respiratory failure or multiple organ failure. 

People can donate plasma more than once, but have to wait several weeks after donating.    

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I had Kawasaki disease and I won't be sending my daughter back to school soon

It was like fire under my skin – an agonising burning sensation, as hot as the fever that sent my temperature through the roof.

The speed at which the disease took hold and consumed me was frightening. Within days I went from being a normal five-year-old, running around the school playground, to being bed-bound and unable to walk.

Days later, when the fever finally subsided, my skin fell off in sheets, like I’d been scorched in the sun. I was too weak to return to school for months. 

More than 30 years on, I remember the horror of having Kawasaki disease, and the look of sheer panic on my mum’s face as she tried to get the doctors to find out what was wrong with me. I couldn’t eat or sleep, and battled the fever for days on end.

At the time, the doctor had ruled out all the usual suspects: meningitis, scarlet fever, glandular fever, measles. It was only years later that another doctor finally gave me a diagnosis.

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Until then, I had never heard of Kawasaki disease, and until very recently, most people probably knew very little about it.

Parents especially will now know its name, and many are no doubt more terrified of this illness than coronavirus, which has cost tens of thousands of lives in the UK alone. 

The disease causes the blood vessels to inflame and makes the coronary arteries swell, which can potentially lead to the infected person having an aneurysm.

Even after its effects have passed, it can be a factor in sudden death years later. 

As a whole, Kawasaki disease is more common in Asia than in Europe, but it’s now also the most common cause of acquired heart disease for children in the developed world.

That its emergence has coincided with the Covid-19 pandemic has understandably led to concerns that it is in some way linked to the virus.

Reports show that 100 children in New York have presented with Kawasaki symptoms, along with more cases in London, Paris and other major cities.

Some children have sadly died. 

It’s with this in mind that I watch reports of the UK government’s plan to send children in England back to school on 1 June.

Little is currently known about the links between Covid-19 and Kawasaki disease, but that knowledge should be learned by scientists – and not with children as guinea pigs

An email from our daughter’s school said that she would be among the first to be allowed to go back. She wants to be reunited with her little friends, and never stops talking about all the people she wants to hug ‘when the germs have gone away’.

But as a mum and dad who have spent most of her first term at school with red eyes and runny noses (and worse), we are all too aware of kids’ amazing ability to spread bugs and bring them back home.  

No matter what efforts the school took to protect my daughter and her playmates, children will be children. They live and learn with their senses – touching, smelling and tasting what’s around them. We could not send her back into a situation where there was a potential for her to become ill.

I imagine many parents are finding it hard to justify a government’s willingness to put the smallest children at the front of this experiment.

Little is currently known about the links between Covid-19 and Kawasaki disease, but that knowledge should be learned by scientists – and not with children as guinea pigs.  

In the beginning, some people were casual about the risk of coronavirus, and seemed almost blasé about it ‘mostly affecting the elderly’. Would they have taken the same view if children made up the majority of its victims? Probably not.

So, the idea that children should now be put into a situation that even the Sage (scientists advising the government) has admitted isn’t without risk, is not one that I am willing to support.  

Our kids trust us to keep them safe.

If I were to send my daughter back to school right now, I might as well let her play in the road, stick her fingers in plug sockets and get into a stranger’s car. 

Having felt the burning pain of Kawasaki disease, I have never wanted to play with fire – and I certainly won’t do it with my child’s safety.

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Saudi Arabia to end virus curfew from June 21

Saudi Arabia will end its nationwide coronavirus curfew from June 21, except in the holy city of Mecca, the interior ministry said Tuesday, after more than two months of stringent curbs.

Prayers will also be allowed to resume in all mosques outside Mecca from May 31, the ministry said in a series of measures announced on the official Saudi Press Agency.

The kingdom, which has reported the highest number of virus cases in the Gulf, imposed a full nationwide curfew during Eid al-Fitr, the Muslim holiday that marks the end of the fasting month of Ramadan.

The ministry said it will begin easing restrictions in a phased manner this week, with the curfew relaxed between 6 am and 3 pm between Thursday and Saturday.

From Sunday until June 20, the curfew will be further eased until 8 pm, the ministry added.

The kingdom will lift the lockdown entirely from June 21.

“Starting from Thursday, the kingdom will enter a new phase (in dealing with the pandemic) and will gradually return to normal based on the rules of social distancing,” Health Minister Tawfiq Al-Rabiah said on Monday.

Saudi Arabia has reported around 75,000 coronavirus infections and some 400 deaths from COVID-19.

In March, Saudi Arabia suspended the year-round “umrah” pilgrimage over fears of the disease spreading in Islam’s holiest cities.

That suspension will remain in place, the interior ministry said.

Authorities are yet to announce whether they will proceed with this year’s hajj—scheduled for late July—but they have urged Muslims to temporarily defer preparations for the annual pilgrimage.

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Type 2 diabetes: Consume this green powder daily to significantly lower blood sugar

A type 2 diabetes diagnosis sends a very clear signal that your blood sugar levels are too high. Blood sugar is a type of sugar that enters your bloodstream through eating food. Type 2 diabetes doesn’t usually produce symptoms in the initial stages but consistently high blood sugar levels, a feature of diabetes, causes the body to undergo adverse changes in the long-run.

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Unstable blood sugar levels may seem benign but it can damage the vessels that supply blood to vital organs.

Eventually, this can increase the risk of deadly complications such as heart disease and stroke.

Luckily, you can bring blood sugar levels under control by making healthy lifestyle changes.

One of the most important adjustments you can make is eating a healthy, balanced diet.

While there is no single miracle worker, evidence shows that specific ingredients have a particularly potent effect on blood sugar levels so it would be wise to include them in your diet.

One ingredient that has yielded promising results is holy basil, a herb that is native to India.

According to medical site LiveStrong, holy basil, taken in powder form, has been shown to lower fasting and post-meal blood glucose levels.

Fasting blood glucose is a test to determine how much glucose (sugar) is in a blood sample after an overnight fast.

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In one study, 40 type 2 diabetics were asked to stop all of their diabetes medications.

Half of the patients were given 2.5g of holy basil leaf powder daily, and the other half were given a placebo for four weeks.

The groups were closely monitored and at the end of the study, holy basil was found to reduce fasting blood glucose levels by approximately 17.6 percent, and post-meal blood glucose levels by 7.3 percent.

Animal studies also support these claims.

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In one study, rats that received holy basil extract saw a 24 percent decrease in blood sugar after 30 days.

Blood sugar in rats that were fed holy basil leaf powder also decreased after a month.

General dietary tips

There’s nothing you cannot eat if you have type 2 diabetes, but you’ll have to limit certain foods.

According to the NHS, you should:

  • Eat a wide range of foods – including fruit, vegetables and some starchy foods like pasta
  • Keep sugar, fat and salt to a minimum
  • Eat breakfast, lunch and dinner every day – do not skip meals

Despite the NHS’s advice, it is important to restrict your intake of starchy items because they are often high in carb.

Carbohydrate is broken down into glucose relatively quickly and therefore has a more pronounced effect on blood sugar levels than either fat or protein.

Type 2 diabetes – how to spot it

“Many people have type 2 diabetes without realising. This is because symptoms do not necessarily make you feel unwell,” says the NHS.

If you do experience symptoms, these can include:

  • Urinating more than usual, particularly at night
  • Feeling thirsty all the time
  • Feeling very tired
  • Losing weight without trying to
  • Itching around your penis or vagina, or repeatedly getting thrush
  • Cuts or wounds taking longer to heal
  • Blurred vision

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Why COVID-19 could make the overdose epidemic worse

When Alberta’s chief medical officer, Deena Hinshaw, announced special exemptions to COVID-19 regulations for group therapy in residential addiction treatment centres, it was exactly what University of Alberta addictions expert Cameron Wild was hoping to hear.

“The whole concept of recovery is in part founded on developing strong social supportive relationships,” said Wild, principal investigator with the Canadian Research Initiative on Substance Misuse in the U of A’s School of Public Health.

“The most commonly used form of treatment in programs throughout North America is founded on 12-step principles—essentially fellowship groups. These traditionally rely on in-person group meetings,” some of which have been severely limited, said Wild.

In other words, isolation and addictions simply do not mix, and Wild worries a rise in overdoses will result.

Just before COVID-19 hit, the number of deaths in Alberta as a result of fentanyl overdoses dropped to the lowest figures in three years, according to new provincial data.

In the final quarter of 2019, 109 people died from a fentanyl-related overdose, down from 158 in 2018 and 178 in 2017. But conditions caused by the pandemic could reverse that encouraging trend, said Wild.

“Any kind of retrenchment of harm reduction services has potential to negatively impact progress we were starting to see in overdose rates in the community.”

Wild and his colleagues across the country have been monitoring changes experienced by people who use drugs during the COVID-19 pandemic, especially marginalized drug users. The researchers are developing guidelines for harm reduction and addiction treatment in light of COVID-19 public health measures.

While outpatient programs now have reduced access, others are doing the best they can to continue operating with public health measures in place, said Wild.

“It’s fair to say addiction treatment has been disrupted. Clinicians across the board are concerned about maintaining critical therapeutic relationships between them and their patients, as well as the supportive social relations that go on in effective group treatment.”

More dangerous street drugs

Besides the disruption of social contact for recovering addicts, the pandemic can bring with it harmful consequences related to the illegal drug trade, said Wild. The closed Canada-U.S. border limits illegal supply, and that could lead to more adulterated and toxic drugs on the street.

“If the drug market is changing, there’s an economic incentive to maximize profit for a reduced number of drug transactions. There’s more motivation to adulterate drug supplies.

“We’re very concerned about that and the impact on drug users,” said Wild.

The pandemic has underscored the reality that many substance abusers are among the most vulnerable in society, said Wild, adding it’s hard to comply with a stay-at-home order if you don’t have a home.

“The impacts for people who are more marginalized are being felt both in drug supply chains and disruption in access to drugs because of concerns about infectious disease transmission.”

Support for substance abuse harm reduction had already been eroding before the pandemic, said Wild, especially in light of a report by the Alberta government’s Supervised Consumption Services Review Committee. It suggested supervised drug consumption sites produce increased needle debris in surrounding neighbourhoods and are a risk to public safety.

“That was the worst possible time for that to have come out,” said Wild.

“We’re really trying to promote the idea that we don’t want to exacerbate overdose death and drug-related problems by restricting harm reduction services further.”

Wild also recommends loosening restrictions on “opioid agonist” treatments such as methadone or buprenorphine to treat addiction to opioids.

“We support things like pharmacists being able to supply longer-term medication that can be more flexibly delivered,” he said.

Increased overall use of alcohol and cannabis

Wild and his colleagues have also been watching a rise in substance use—especially alcohol and cannabis—in the general population while people are sheltered at home during the pandemic.

According to a recent poll by the Canadian Centre on Substance Use and Addiction, 25 percent of Canadians aged 35–54 are drinking more at home, citing lack of a regular schedule, stress and boredom as the main reasons.

“We’re concerned about broader general population changes in substance use patterns triggered by some of the isolation and distancing issues that people are being asked to adopt.”

Wild said he hopes the experience of addicts will give us all fresh eyes to re-evaluate addictions services.

“This is a chance to look with a very sober eye at the patchwork of services that existed prior to the pandemic,” he said. “We need to reconsider several key components in how we respond to addiction.

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